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Coda Change

Jun 25, 2021

How a Crisis Resource Management failure led to a full-blown medical emergency.  

It is estimated that 70% of avoidable deaths in healthcare involve a breakdown of the principles of CRM.

Crisis resource management, involves seven crucial steps:

  1. Know your environment
  2. Anticipate and plan
  3. Take a leadership role
  4. Communicate effectively
  5. Call for help early enough
  6. Allocate attention wisely, use all information
  7. Distribute workload, use all available resources

Unfortunately, a failure in adhering to the 7 principles of CRM lead to serious complications for the birth of Tamara & Garry Hills’s son.

We hear from Tamara and Garry as they explain the human and systemic factors that ultimately led to a full-blown medical emergency.

A lack of situation awareness, combined with poor communication, unfortunately led to Christopher Hills suffering a severe brain injury. This likely occurred during the 17 minutes of terminal Bradycardia.

Tamara, Garry and Christopher bravely share their story to inspire healthcare workers to embrace crisis resource management.

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